Analytics and ACOs

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Analytics and ACOs
Analytics and ACOs

Long-term care operators will need to collaborate more with hospitals, physicians, healthcare networks and other organizations to improve care and reduce costs, under newly-proposed federal regulations for Medicare accountable care organizations.

Operators will need to create and manage robust health information technology. Among the primary challenges facing the field: ensuring new data management systems are comprehensive, compatible and transparent. While some early adopters are already preparing for changes to come, others are taking more of a wait-and-see approach.

Regardless, experts largely agree on one thing: Whether the ACO model makes it through as proposed or undergoes significant change, the concept of bundled payment and the push for improved care quality is here to stay.

“It's a given that healthcare is going to undergo a fundamental reinvention in this country,” said Loren Claypool, managing director of VCPI and chief information officer of Extendicare, Milwaukee. He reasoned that ACOs are essentially the delivery vehicle for moving episodic bundled payments, cost reduction and improved care goals across the finish line. The bottom line, according to Claypool, is that the way things are now done will need to change. Post-acute care providers will need to strategically position themselves, lest they run the risk of being shut out of the ACO market altogether.

“We're probably going to see the definitions of ACOs change, but what's not going to change is the drive [toward] episodic bundled payments. It'll be necessary for businesses to position themselves to succeed as we undergo this reinvention,” Claypool advised.

EMR moves to forefront

Staying viable – and valuable – in an ACO environment requires a solid electronic medical record. Electronic data sharing, after all, is the foundation of cost reduction and care quality improvement in which the ACO model is built.

“An electronic medical record is what allows you to share information and avoid duplicating efforts,” reasoned Teresa Chase, president of American HealthTech. “Even before ACOs hit us in 2012, the momentum for EMR is going to pick up because as of Oct. 1, hospitals will be facing rehospitalization penalties and they're going to want – and need – electronic information on post-acute care providers' outcomes. Data transparency has to happen for these types of collaborative relationships [between care settings] to occur.”

Just having EMR capabilities won't suffice, however. As one political economy expert recently noted, a robust information infrastructure is required for any economic activity to run successfully. This structure must simultaneously achieve two goals: provide management with the information needed to operate the activity efficiently, and to the standards of quality; and force the managers of the activity to be accountable for the resources used in the enterprise and the quality of output achieved.

“So far, our health sector has spared the second requirement and has achieved even the first one only haphazardly,” said Uwe Reinhardt, Ph.D., an economics professor at Princeton University. He added that many ACO provisions “are aimed at rectifying this deficiency.”

There's little doubt that having the ability to capture and analyze data will play a key role in a sub-acute care provider's ability to partner with an ACO. “As you work through the proposed rule, data collection and analytics are defined as keys to an ACO's success – and also a practical component to improving the delivery of quality care,” Claypool said.

Specifically, ACOs will be seeking sub-acute care partners that are able to manage residents effectively in their care setting, without sending them to the hospital or emergency department.

“That means several things for skilled nursing providers. First, the nursing skill sets for both sub-acute and long-term care residents needs to be really sharp, so providers will need to focus on assessments to determine the person's risk for decline or hospitalization,” explained Kathleen Griffin, Ph.D., national director of post-acute and senior services for Health Dimensions Group. She added that facilities will have to collect data daily on all rehospitalizations, while also trending on an aggregate monthly basis.

“You'll be looking at the type of patient, their risks and characteristics, who the primary care physician or nurse practitioner was, how long that individual was in your facility before hospitalization, and so on,” she continued. “You'll also be collecting data on the difference you made in the functional ability of sub-acute patients and the prevention of decline in long-term care residents.”

Sub-acute care providers must also collect resident and family satisfaction data and then share that information with other care partners in a meaningful way.

“If you want your data and reports to be understood by an ACO or hospital, you'll need to use HCAP language,” stressed Griffin.

Granular data gets results

Thriving in an ACO world also will require providers to get granular on per-resident costs to determine overall cost per stay, adds Steven Littlehahale, who is Executive Vice President, Healthcare & Chief Clinical Officer for PointRight. PointRight specializes in delivering data-driven analytics and decision support services to the long term care, assisted living and insurance fields.

“Nursing homes are appropriately adept in discussing functional performance and psychosocial needs but less so when it comes to disease diagnosis,” he notes. He adds that hospitals “are just the opposite.”

“It will take a few years, and great care, before we have successful data-driven conversation across the care continuum. Proactive providers accustomed to analytics will get there first," he predicts.

Griffin adds that getting granular will require long-term care operators to manage information in ways that once seemed unfathomable. “For example, An ACO will want to be able to predict how much, on average, it's going to cost for a 75- to 90-year-old congestive heart failure patient with two activities of daily living dependencies to go through your sub-acute care rehab and then home – without rehospitalization for 90 days,” Griffin reasoned. “You do that by stratifying your residents under various parameters. You'll need to do this if you're going to be considered a good, quality, cost-effective partner.”

Understanding outcomes and cost basis by Diagnosis Related Group – the RUGs-like term used by hospitals – will also be essential for skilled nursing facilities as they negotiate their way into an ACO, added Claypool.

Above all, though, sub-acute care facilities must be able to sit down at the ACO table and present their data in a way that clearly demonstrates an ability to help that ACO deliver on its promise of providing the highest quality of care at the lowest cost. In many cases, it'll be difficult for providers to gather the necessary information on their own.

“We're moving from collecting and reporting data to more analysis and decision support, and it's really going to be a challenge for a person to do that all on his or her own,” said Chase. “We'll need good analytical tools to help prompt us and make sure we're not missing something along the way.”

Taking time to review hospital data is also prudent for sub-acute care providers who want to position themselves well at the ACO table.

“There's a lot of available data that can give you a pretty good indication of a hospital's problems before ever sitting down with them,” Claypool noted. “If you know you've got a good track record, talent, skills and abilities to positively impact them [and can support that with data], imagine the conversation you'll have with that hospital CFO or CEO. You won't be coming with your hat in your hand begging for [business]. You'll be coming with a solution to a problem that the hospital is experiencing now, and that the ACO will inherit once it forms.”

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